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Progress has been made towards reducing the 85% of wasted effort in medical research—and the huge amounts of money misspent and harm caused to patients—but there’s still a long way to go, say Paul Glasziou and Iain Chalmers

In their history of the evolution of guidelines for reporting medical research, Doug Altman and Iveta Simera showed that poor design, conduct, and reporting of medical research have been concerns for over a century: “The quality of published papers is a fair reflection of the deficiencies of what is still the common type of clinical evidence. A little thought suffices to show that the greater part cannot be taken as serious evidence at all.”1

Indeed, more than 250 years ago, the Scottish doctor James Lind declared in the introduction to his review of reports on treating scurvy: “Before this subject could be set in a clear and proper light it was necessary to remove a great deal of rubbish.”2

Quantifying the extent of poor reporting of medical research seems not to have begun until 1966 (box). After assessing 295 publications in 10 “most frequently read” medical journals, Schor (a statistician) and Karten (a medical student) concluded: “In almost 73% of the reports . . . conclusions were drawn when the justification for these conclusions was invalid.”3

However, the title of their article, “Statistical evaluation of medical journal manuscripts,” was unlikely to ignite action among clinicians to deal with a situation that threatened their patients’ wellbeing.

The wake-up call came 30 years later, in 1994, with an editorial in The BMJ by the journal’s chief statistical adviser, Doug Altman. He described as a scandal4 that “huge sums of money are spent annually on research that is seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect …